Boxcar scars are visually seen as a deep angular dent to the skin that is similar to chickenpox scars. (Example of boxcar scar above)
Boxcar often comes from serious inflamed acne that has destroyed the skin. (Usually cyst) As a result, tissue is lost and the skin around the area is left unsupported, allowing the sink to sink below normal level.
The disturbingly large holes that you see above is where cyst acne used to occur. Those large holes were indeed from popping and picking on the cysts.
(In case if you’re wondering, the image provided above is my skin before I had any treatment done)
There are different appearance and size that boxcar scars comes in. Luckily, boxcar scar is one of the easiest scars to treat. With many different treatments offered for both home and professional use, I have listed below all the treatments in two categories.
Among popular treatment for boxcar scars is laser resurfacing. It works by using high intensity heat to burn off the upper layer of the skin to reduce the depth of the boxcar scar.
How it works
An invisible beam is aimed towards the boxcar, which will cause the healing of the cell and making them die off. The water below will boil on a cellular level to make this possible. As this occurs, collagen production is stimulated and increased to aid in replacing the loss tissue.
Although skin is essentially removed and put back together by collagen, this technique is to reproduce more skin elastic than what was removed.
New skin that is produce will be much smoother and less blemished.
Note: I’ve listed chemical peels here as professional use, but it can also be done at home. However, medical doctors have access to stronger acid strength that is not available to the public
Chemical peels work in the same way as laser resurfacing, where the burning of the upper layer of skin is done.
How it works
An acid peel solution is applied onto the designated boxcar scar, and it will proceed to heat the skin cell. As it becomes hot within the acid peel, skin cells begin to die off. There will be a burning sensation, so a numbing cream may be used if you are not pain tolerable.
When the skin is burned off, it will go through the same process as the laser treatment, where collagen is produced to repair the loss tissue.
Boxcar scars responds much better in high concentration of TCA (around 80%-100%). Anything lower will not have much of an improvement. Source: Dr. Bryan Chen
Punch technique is best done for boxcar scars that are deep.
How it works
A punch biopsy tool is used (which looks like a small cookie cutter) to cut the boxcar from the skin, which later on gets grafted back by stiches or related skin glue substances.
Before the skin gets grafted back on, doctors will elevate the base of the boxcar below to make it level up evenly with the surround skin.
There will be scarring, as a result, but the new scar will fade overtime.
Results of Treatments
The downtime will takes months to recover, although normal activities can resume after two weeks. Sunlight should be avoided during the two weeks as well.
At all times, sunscreen (preferably SPF 60) should be applied when going outside. It is normal for the skin to start peeling within a few days.
A dermaroller or a dermastamp is often used to penetrate the dermis below the skin. In doing so, this will cause micro tears. Your body will promotes more collagen growth than needed, which allows any tissue damage to be healed to collagen aid, including boxcar scars.
This can be done through a surgeon or at home. Typically, doing it at home will be much more cost effective, saving you hundreds of dollars. To read more information about how you can start doing needling on yourself, it is highly recommended that you visit this section here for further information.
Result of Skin Needling
Skin needling will result in very similar outcome to laser and chemical peel treatments. You should expect a downtime of 4 to 8 weeks. During your first week, it is in your best interest to avoid any direct sunlight to not cause internal skin damage.
Which Treatment Is Right For You?
I cannot give you a definite answer, as you would need to see what is right for you. Talk to your dermatologist about this if you need. Each treatment may favor better to you in terms of your skin genetic and thickness.
Chemical peels and micro needling can both be bought online to do at home. You can buy your chemical peel here.
Skin needling is much more complicated and will require more attention needs. Please visit this page if you wish to learn more about doing micro-needling at home.Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168245/